The Maryland Department of Health (Department) is responsible for evaluating the quality of care provided to eligible enrollees by contracted managed care organizations (MCOs) through the Maryland Medicaid Managed Care Program, known as HealthChoice. HealthChoice operates under a Centers for Medicare & Medicaid Services (CMS) 1115 waiver of the Social Security Act and Code of Maryland Regulations (COMAR) to serve Marylanders on Medicaid. Guiding principles for HealthChoice’s operations are to provide quality healthcare that is equitable, patient-focused, prevention-oriented, coordinated, accessible, and cost-effective.
Federal regulations require the Department to contract with an external quality review organization (EQRO) to provide annual, independent reviews for assessing quality, access, and timeliness of care. This independent review ensures services provided to enrollees meet the standards governing the HealthChoice program in the Code of Federal Regulations (CFR) and COMAR. The Department contracts with Qlarant to meet federal regulations; evaluate quality, access, and timeliness of care; and validate encounter data.
Hilltop performed Activity 3 of this evaluation, which is included in Appendix A of Qlarant’s report.
In 1997, Maryland implemented HealthChoice—a statewide mandatory Medicaid and Children’s Health Insurance Program (CHIP) managed care program—under authority of a waiver through §1115 of the Social Security Act. The provisions of the Affordable Care Act (ACA) that went into effect in 2014 marked another milestone by extending quality coverage to many more Marylanders with low income. Over 25 years after its launch, HealthChoice covers close to 90% of the state’s Medicaid and Maryland Children’s Health Program (MCHP) populations. Since the inception of HealthChoice, the Maryland Department of Health (the Department) has requested and received seven §1115 waiver renewals.
The Hilltop Institute, on behalf of the Department, evaluates the program annually; this evaluation covers the period of calendar year (CY) 2019 through CY 2023.
In 1997, Maryland implemented HealthChoice—a statewide mandatory Medicaid and Children’s Health Insurance Program (CHIP) managed care program—under authority of a waiver through §1115 of the Social Security Act. The provisions of the Affordable Care Act (ACA) that went into effect in 2014 marked another milestone by extending quality coverage to many more Marylanders with low income. Over 25 years after its launch, HealthChoice covers close to 90% of the state’s Medicaid and Maryland Children’s Health Program (MCHP) populations. Since the inception of HealthChoice, the Maryland Department of Health (the Department) has requested and received seven §1115 waiver renewals.
The Hilltop Institute, on behalf of the Department, evaluates the program annually; this evaluation covers the period of calendar year (CY) 2018 through CY 2022.
Assistance in Community Integration Services (ACIS) is a pilot program that is operated under Maryland’s §1115 demonstration waiver for HealthChoice, the state’s Medicaid managed care program launched in 1997. Under this pilot, the state provides a set of home and community-based services (HCBS) to a population that meets certain needs-based health and housing eligibility criteria. This summary report discusses ACIS program goals, eligibility criteria, services, and participating lead entities, followed by the study objectives, research methodology, key findings, and study limitations.
In 1997, Maryland implemented HealthChoice—a statewide mandatory Medicaid and Children’s Health Insurance Program (CHIP) managed care program—under authority of a waiver through §1115 of the Social Security Act. The provisions of the Affordable Care Act (ACA) that went into effect in 2014 marked another milestone by extending quality coverage to many more Marylanders with low income. Over 20 years after its launch, HealthChoice covers close to 90% of the state’s Medicaid and Maryland Children’s Health Program (MCHP) populations. Since the inception of HealthChoice, the Maryland Department of Health (MDH) has requested and received seven §1115 waiver renewals.
The Hilltop Institute, on behalf of MDH, evaluates the program annually; this evaluation covers the period from CY 2017 through CY 2021.
The objectives of this research are to determine a potential policy alternative to the current recommended budgeting methodology and to simulate the gains in administrative efficiency on actual Maryland Medicaid data from FY 2019. The broader hope is that this study can potentially serve as a guide to other states that are considering adoption of the Community First Choice program.
Senior Director of Research and Analytics/Chief Data Scientist Ian Stockwell, PhD, and Principal Data Scientist Morgan Henderson, PhD, co-authored this article published in the American Journal of Managed Care.
In 1997, Maryland implemented HealthChoice—a statewide mandatory Medicaid and Children’s Health Insurance Program (CHIP) managed care program—under authority of a waiver through §1115 of the Social Security Act. The provisions of the Affordable Care Act (ACA) that went into effect in 2014 marked another milestone by extending quality coverage to many more Marylanders with low income by calendar year (CY) 2018. Over 20 years after its launch, HealthChoice covered close to 90 percent of the state’s Medicaid and Maryland Children’s Health Program (MCHP) populations.
The Hilltop Institute, on behalf of the Maryland Department of Health (the Department), evaluates the program annually; this evaluation covers the period from CY 2016 through CY 2020.
In 1997, Maryland implemented HealthChoice—a statewide mandatory Medicaid and Children’s Health Insurance Program (CHIP) managed care program—under authority of a waiver through §1115 of the Social Security Act. The provisions of the Affordable Care Act (ACA) that went into effect in 2014 marked another milestone by extending quality coverage to many more Marylanders with low income by calendar year (CY) 2018. Over 20 years after its launch, HealthChoice covered close to 90 percent of the state’s Medicaid and Maryland Children’s Health Program (MCHP) populations.
The Hilltop Institute, on behalf of the Maryland Department of Health (the Department), evaluates the program annually; this evaluation covers the period from CY 2015 through CY 2019.
In 1997, Maryland implemented HealthChoice—a statewide mandatory Medicaid and Children’s Health Insurance Program (CHIP) managed care program—under authority of a waiver through §1115 of the Social Security Act. The provisions of the Affordable Care Act (ACA) that went into effect in 2014 marked another milestone by extending quality coverage to many more Marylanders with low income by calendar year (CY) 2018. Over 20 years after its launch, HealthChoice covered close to 90 percent of the state’s Medicaid and Maryland Children’s Health Program (MCHP) populations.
The Hilltop Institute, on behalf of the Maryland Department of Health (the Department), evaluates the program annually; this evaluation covers the period from CY 2014 through CY 2018.
In 1997, HealthChoice—Maryland’s statewide mandatory Medicaid and Children’s Health Insurance Program managed care program—became operational as a waiver of standard federal Medicaid rules, under authority of §1115 of the Social Security Act. The Centers for Medicare & Medicaid Services approved subsequent waiver renewals in 2005, 2007, 2010, 2013, and 2016. The Maryland Department of Health continually monitors HealthChoice performance on a variety of measures across the demonstration’s goals, culminating in an annual evaluation. This report—the 2019 annual evaluation—includes data from calendar year (CY) 2013 through CY 2017.